Surgery for Aneurysms of the Aortic Root

Abstract

Background-This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Methods and Results-Two-hundred three patients aged 53Ϯ16 years (meanϮSD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (PϭNS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] ϭ 88% to 97%), 79% (95% CI ϭ 71% to 87%), 67% (95% CI ϭ 57% to 79%), and 52% (95% CI ϭ 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI ϭ 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI ϭ 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI ϭ 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (ϩ3 to 4) and older age to be significant predictors of late death (PՅ0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (PՅ0.01). Conclusions-Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.

Análise do tratamento cirúrgico da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica

“…The late mortality of these patients is low, similar to the life expectancy of the general population, as demonstrated previously [17]. Renal failure, being dialytic or not, it is a factor that is invariably associated with higher mortality, either early or late.…”

“…Niederhäuser et al [16], with seven reoperations in 181 patients operated with a valved conduit, did not identify predictors for the need of reoperation. On the other hand, Zehr et al [17] in a series of 203 surgical patients observed that Marfan syndrome, root reconstruction with the aortic valve preservation and the need of associated valvular procedure were significant predictors for necessity of reoperation.…”

The Anesthetic Management of a Patient with Marfan Syndrome and Renal Transplant Patient Undergoing Bentall Operation

“…İlk olarak yapıldığı 1968 yılından beri orijinal teknikte birkaç değişiklik yapılmış olmakla birlikte günümüzde de bütün dünyada yaygın olarak uygulanmaktadır. Yapılan çalışmalara göre assenden aortanın koruyucu ameliyatları ile karşılaştırıldığında, Bentall tekniğinin MFS hastalarında hem reameliyat sayısını azalttığı hem de kısa ve uzun süreli sonuçlarının daha iyi olduğu belirtilmektedir (2) .…”

“…Proksimal aortanın ilerleyici olarak genişlemesine bağlı bu komplikasyonlara zaman için-de aort kapak yetmezliği de eklenmektedir. Yapılan son araştırmalara göre; MFS hastalarında yalnızca proksimal aorta replasmanı yerine proksimal aorta ve aort kapak replasmanlarının birlikte yapılması durumunda normal yaşam süreleri elde edilebildiği gibi reameliyat insidansı da azalmaktadır (2) .…”

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

“…66 The risks associated with descending thoracic aortic repair are 2-fold higher, 67 and those for extensive thoracoabdominal aortic disease are double that. 68 Complications from surgical repair include hemorrhage, postoperative paraplegia from spinal cord ischemia for descending thoracic repair, and stroke from cerebral ischemia during arch repairs.…”